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Adult Language Disorders (Aphasia)

The purpose of this project is to educate and provide information to clients and their families in order to enable them to better understand what aphasia is. The information provided will describe the prevalence, causes, and various treatments for the different types of aphasia. When clients are done reading this wikipage, they will have a clearer understanding of aphasia

Aphasia
The loss of ability to understand or express speech, caused by brain damage, brain injury, or brain infections. Damage is usually, but not always on the left side of the brain.

Characteristics/Symptoms

The main symptoms of aphasia include:
  • Trouble speaking
  • Struggling with finding the appropriate term or word
  • Using strange or inappropriate words in conversation
  • Trouble reading and writing
  • Cognitive skills are normally good

Some people with aphasia have problems understanding what others are saying. The problems occur particularly when the person is tired or in a crowded or loud environment. Aphasia does not usually affect cognitive skills. However, the person may have problems understanding written material and difficulties with handwriting. Some people have trouble using numbers or even doing simple calculations.

Characteristics of Mild Aphasia:
  • may be able to carry on normal conversations in many settings
  • may have trouble understanding language when it is long and/or complex
  • may have trouble finding the words (called anomia) to express an idea or explain himself/herself-this is like having a word "on the tip of your tong
  • mon characteristic of global aphasia is that the patient may use verbal stereotypes which are essentially one-word responses to every question posed to them. For example, the patient might say, "yes" to every question or "okay" to every question or even "whatever" to every question.
  • ue"

Characteristics of Severe Aphasia:
  • may not understand anything that is said to him/her
  • may say little or nothing at all
  • may make approximations of common phrases, such as "yes", "no", "hi", and "thanks"

Characteristics of Expressive Aphasia:
  • Speaks only in single words (e.g., names of objects)
  • Speaks in short, fragmented phrases
  • Omits smaller words like "the", "of", and "and" (so message sounds like a telegram)
  • Puts words in wrong order
  • Switching sounds and/or words (e.g., bed is called table or dishwater a "wish dasher")
  • Makes up words (e.g., jargon)
  • Strings together nonsense words and real words fluently but makes no sense

Characteristics of Receptive Aphasia:
  • Requires extra time to understand spoken messages (e.g., like translating a foreign language)
  • Finds it very hard to follow fast speech (e.g., radio or television news)
  • Misinterprets subtitles of language-takes the literal meaning of figurative speech (e.g., "it's raining cats and dogs")
  • Is frustrating for the person with aphasia and for the listener -- can lead to communication breakdown

Types of Aphasia

  • external image receptive+aphasia.jpgNonfluent (expressive) aphasia - difficulty communicating both orally (speech) and writing
    • Broca's aphasia
      • A typical patient with this type of aphasia will typically omit various grammatical elements (i.e. the plural inflection -s or the past inflection -ed), lack intonation, have impaired repetition, the presence of apraxia, and shows good comprehension.
    • Transcortical motor aphasia
      • A typical patient with transcortical motor aphasia will present very similar to that of a patient with Broca's aphasia; however, a patient with transcortical motor aphasia will have good imitation of speech.
    • Global aphasia
      • Patients who present with global aphasia have the most severe form of aphasia. In this type, all language functions of speech are affected. One com
      • Fluent (receptive) aphasia - fluent but meaningless speech
    • Wernicke's aphasia
      • Patients who present with Wernicke's aphasia have fluent but meaningless speech, good articulation and intonation, and impaired auditory comprehension of speech.
    • Conduction aphasia
      • Patients who present with conduction aphasia present with marked difficulty in repeating words and phrases, minor comprehension issues, and somewhat fluent speech.
    • Anomic aphasia
      • Patients who present with anomic aphasia tend to have a word-finding problem, near normal language as well as good comprehension.


Causes

  • Stroke
  • Brain tumor
  • Brain damage
  • Brain infections

Prevalence

  • According to ASHA, there are roughly one million individuals in the United States who live with aphasia. That would calculate out to be roughly 1 in every 250 Americans who have a diagnosis of aphasia.
  • About 80,000 new cases of aphasia are diagnosed yearly.
  • Researchers have found that about fifteen percent of individuals under the age of sixty-five are diagnosed with aphasia. However, this percentage rises drastically in the population of people over eighty-five years old with a rate of forty-three percent.
  • Research shows that aphasia affects both women and men equally. However, it has been noted that depending on the type of aphasia, one gender may be affected more so than the other. For example, Wernicke's and global aphasia occur more commonly in women; whereas, more men tend to be diagnosed with Broca's aphasia.

Diagnosis - What to expect

  • Usually aphasia is recognized by a physician, such as a neurologist. The patient is then referred to a speech-language pathologist. A speech-language pathologist will assess the disorder and treat accordingly. A typical assessment includes measurement of: general language performance, functional communication, auditory comprehension, oral expressive language, reading and writing skills, gestures and other nonverbal means of communication, conversational skills, and specific aspects of language (phonological, syntactic, pragmatic, morphological, and pragmatic). Speech-language pathologists tend to use various standardized tests as well as general everyday conversation in order to diagnose aphasia and determine a course of treatment.

Treatment


The course of treatment depends on factors such as:
  • Age
  • Cause of brain injury
  • Type of aphasia
  • Position and size of the brain lesion

For instance, a person with aphasia may have a brain tumor that's affecting the language center of the brain. Surgery to treat the brain tumor may also improve the aphasia.
A speech-language pathologist working with a patient who has aphasia
A speech-language pathologist working with a patient who has aphasia


A person with aphasia who has had a stroke may benefit from sessions with a speech-language pathologist. The therapist will meet regularly with the person to increase his or her ability to speak and communicate. The therapist will also teach the person ways to communicate that don't involve speech. This will help the person compensate for language difficulties.

The speech-language pathologist (SLP) works on drills and exercises to improve specific language skills affected by damage to the brain. For example, the person may practice naming objects, following directions, or answering questions about stories. These exercises vary depending on individual needs and
become more complex and challenging as skills improve. The SLP also teaches the person ways to make use of stronger language skills. For example, some people may find it easier to express their ideas through gestures and writing than with speaking. The SLP may teach this person to use both writing and gestures to help remember words for conversation.

What you, as either the patient or family member, should be doing.

  • As the patient or caregiver, you should understand the treatment protocol. This means that you should understand how often you must come in for therapy or what type of drills you should be doing at home to aid the therapy received by the SLP.
  • Keeping your scheduled therapy sessions is the key to success. By missing therapy sessions, your or your loved one may not be able to make as great a recovery as you wish. Always know when and where your appointments are. It is crucial that you keep all appointments.
  • It is very important that you understand the treatment plan that the SLP has developed specially for you or your loved one. If you do not understand the plan completely, you should ask the therapist to further clarify.
  • One very important fact that you should also be aware of is that recovery is oftentimes a very slow process. Usually if symptoms of aphasia last longer than two-three months, it is highly unlikely for a full recovery. Though, you should also understand that progression can be seen over months, years or even decades after onset of aphasia.

Coping Strategies

Here are some tips from the National Stroke Association for someone with aphasia:
  • Use props to help get the message across.
  • Draw words or pictures on paper when trying to communicate.
  • Speak slowly and stay calm when talking.
  • Carry a card to let strangers know you have aphasia and what how it affects you.

To watch other patient's stories regarding their struggles with aphasia, you can watch Inside Aphasia. It is a YouTube video broken into three parts.

Resources
Aphasia. (n.d.). ASHA. Retrieved from http://www.asha.org/public/speech/disorders/Aphasia/

Aphasia Frequently Asked Questions. (n.d.). The National Aphasia Association. Retrieved from http://www.aphasia.org/Aphasia%20Facts/aphasia_faq.html

Effects of Stroke. (n.d.). National Stroke Association. Retrieved from http://www.stroke.org/site/PageServer?pagename=aphasia#manage

Family Adjustment to Aphasia. (n.d.). ASHA. Retrieved from http://www.asha.org/public/speech/disorders/FamilyAdjustmentAphasia/

Hegde, M. N. (2010). Medical Speech-Language Pathology. Introduction to communicative disorders (4th ed., pp. 351-418). Austin, Tex.: Pro-Ed.